Analysis of near miss cases as a reflection of emergency obstetric services and need of obstetric ICCU

Abstract

Objectives: World Health Organization (WHO) has defined near miss case as 'a woman presenting any life-threatening condition and surviving a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy'. This study aims to calculate near miss rate (NMR), maternal mortality rate (MMR), severe maternal outcome ratio, and near miss maternal death of our hospital. Indications of near miss events (NME) and their mortality index and the incidence of each organ dysfunction and its mortality index have been studied. Design: A retrospective study of hospital records was done to complete proforma and summarize obstetric and perinatal events from April 2011 to October 2011 at Civil Hospital, Ahmedabad. Near miss events were identified according to criteria of organ dysfunction given by Mantel et al 1998. Results: Out of total 3, 242 live births, 97 NME occurred among which 27 expired. Thus, NMR and MMR of our hospital is 21.5 per 1,000 and 832.8 per 100,000 live births respectively. Severe maternal outcome ratio is 29.9 (97/3242) and maternal mortality to near miss ratio is 1:2.58. Mortality index of our institute is 27.8% (27/97). 80.4% patients developed NME before hospitalization. Severe-PIH was the most common cause of NME but carried a low mortality index of 5.8%. Whereas, complicated cases of malaria and hepatitis E had high mortality index of 75 and 38.8% respectively. Conclusion: This study describes a relatively high mortality index and NMR (21.5/1,000 live births) as compared to data from other developing countries.